Transforming Provider Data

There is no better time for the health IT community to come together under one umbrella to raise national awareness of the benefits information technology can bring to the US health system. National Health IT (NHIT) Week is a nationwide awareness week focused on the value of health IT. Each year, NHIT Week Partners educate industry and policy stakeholders on the value of health IT for the US healthcare system. Every Tuesday leading up to NHIT Week, our valued partners will share their voice and experience on how they demonstrate the value of health IT.

The U.S. healthcare system relies on accurate and up-to-date provider data in almost every transaction and activity. Provider information is necessary to support core business functions, such as connecting patients with providers, managing insurance claims and ensuring program integrity. When provider data contains inaccuracies, the cost of delivering healthcare increases along with the administrative burden of redundant tasks and time spent making corrections.

By CAQH estimates, the healthcare industry spends more than $2 billion annually to attain and manage provider data. Despite these efforts, inaccuracies persist. Real progress demands full industry collaboration and harmonized health IT approaches. The challenges of maintaining accurate provider data touch everyone in the healthcare system.

Consider provider directories as an example

Think about this: A medical practice on average contracts with 12 health plans – each conducting regular outreach to maintain an updated provider directory. If a practice has five physicians, the office is receiving dozens of inquiries every month requesting the same information in different formats.

Due to this time-consuming burden, providers may not report new information and important changes to health plans and other healthcare organizations in a timely manner. Meanwhile, health plans are under fire to meet federal and state directory regulations or face significant penalties. And of course, patients need reliable, accurate information to find a healthcare provider who is easily accessible and accepts their insurance.

No one disputes that accurate provider data is critical and that there will be barriers to overcome in developing consensus on solutions. For instance, many stakeholders have already invested extensive resources conceptualizing, building and implementing proprietary systems to maintain provider data for their own internal processes.

Focus collaboration on producing efficiencies

Bringing together stakeholders to address longstanding provider data issues has the potential to revolutionize the quality of data to support healthcare transformation. Collaboration that focuses on producing efficiencies will bring new insights for solutions that can address longstanding provider data problems.

To support collaborative discussions, CAQH developed a white paper that describes the challenges and environmental pressures on industry efforts to collect and maintain accurate provider data. CAQH also convened an industry-wide 2016 Provider Data Summit of more than 100 industry leaders who identified priorities for solving provider data challenges. The group analyzed how best to develop industry-accepted data definitions, improve maintenance processes and accountability measures, centralize data resources and foster greater regulatory alignment.

Following the Summit, CAQH brought together more than 20 participants from across healthcare to form the Provider Data Action Alliance. Participants represent health, dental and vision plans, hospitals and health systems, provider organizations, health information exchanges and government agencies. Based on these varied viewpoints, the Alliance has developed a shared industry vision and drafted a corresponding industry roadmap to address many of the provider data challenges.

The Provider Data Roadmap

The Provider Data Roadmap, which is open for industry comment, offers recommendations on how to:

o Achieve the widespread adoption necessary to systematically address provider data problems.

o Address the significant issues that obstruct the use and transmission of complex provider data across organizational boundaries.

o Coordinate an acceptable industry-wide provider data infrastructure.

o Approach improved standards of accuracy and efficiency in provider data.

Adequately exploring and addressing provider data issues requires diverse, real-world perspectives. An inclusive approach will enable the industry to consider all facets of provider data challenges, as well as what is necessary and efficient for health IT solutions to enable complete, timely, and accurate provider data. Now is the time for the healthcare industry to work together and finally solve these issues.